What is it about?

This study explored the opportunities and challenges facing Nepal’s health system as it adapts to federalisation. This exploratory qualitative study was conducted across the three levels of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders’ practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework.

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Why is it important?

The study found both opportunities and challenges around each WHO building block. Key opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, challenges were: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting.


For Nepal to succeed in its federalisation process, we need to understand the challenges and opportunities. This understanding is needed at each of the three levels of the health system. We need to consider issues of: (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system.

Prof. Edwin R van Teijlingen
Bournemouth University

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This page is a summary of: Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks, Health Research Policy and Systems, November 2023, Springer Science + Business Media,
DOI: 10.1186/s12961-023-01033-2.
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